2. Scrotum
varicocele
a group of dilated veins caused by venous return obstruction
signs and symptoms of epididymal cyst
painless extratesticular scrotal mass
signs and symptoms of spermatocele
painless extratesticular scrotal mass
sonographic appearance of seminoma
solid, hypoechoic homogeneous mass
cremaster muscle
Covers testis and spermatic cord Raise and lowers testis to control temp
sonographic appearance of an adenomatoid tumor (scrotum) benign
small, solid, hypoechoic to hyperechoic
valsalva maneuver
a technique in which the patient is asked to bear down to increase the intra-abdominal pressure and aid in the diagnosis of varicocele and scrotal hernia
sonographic appearance of a scrotal tumor
solid hypoechoic intratesticular mass
sonographic appearance of an epidermoid cyst
solid hypoechoic intratesticular mass, usually with concentric hyperechoic layers (onion sign)
scrotum
the double pouch of the male that contains the testicles and part of the spermatic cord
vas deferens
the excretory duct of the testis; transports sperm from each testis to the prostatic urethra
What are sperm and where are they formed ?
the mature male sex of germ cell formed within the seminiferous tubules of the testes
testicular vein
the pampiniform plexus forms each testicular vein; the right testicular vein drains directly into the inferior vena cava (think, right to it!!") the left testicular vein drains into the left renal vein (think, it takes Longer)
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vas deferens (expels /propels sperm)
dilated veins of a varicocele will measure - >8mm - >4mm - <2mm - >2mm
>2mm
Omentum
A double fold of peritoneum
Hematoma
A swelling or mass of blood confined to an organ, tissue or space
Microlithiasis
Calcifications within the seminiferous tubules
mediastinum testis
Central linear structure formed by the convergence of multiple, thin septations within the testicle, which are invaginations of the tunica albuginea
cremasteric artery
aka external spermatic artery Small artery arising from the inferior epigastric artery, which supplies the peritesticular tissue, including the cremaster muscle
hyperemia
an increase in blood flow to the tissue
testicular artery
artery arising from the aorta just distal to each renal artery
Which of the following houses the male urethra? - Corpus spongiosum - Buck fascia - Bulbourethral gland - Corpus cavernosum
corpus spongiosum
pyocele
pus located between the visceral and parietal laters of the tunica vaginalis
Centripetal artery
terminal intratesticular arteries arising from the capsular arteries
A 23-year-old man presents to the sonography department with a history of infertility. Which of the following is associated with male infertility? - Spermatocele - Choriocarcinoma - Varicocele - Hydrocele
varicocele
Epididymis
A small, oblong body resting on and beside the posterior surface of the testes and consisting of convoluted to tubules 13 to 20 feet in length
Choriocarcinoma
An extremely rare, very malignant neoplasm
The lack of the normal fixation of the testis to the posterior scrotal wall is referred to as: - Klinefelter syndrome - Blue dot sign - Bell-clapper deformity - Cryptorchidism
Bell-clapper deformity
Mediastinum testis
The second portion of the tunica albuginea on the posterior surface of the testis
Which of the following would most likely resemble a solid intratesticular mass and be associated with Cushing syndrome? - Choriocarcinoma - Epidermoid cyst - Intratesticular varicocele - Adrenal rest
adrenal rest
What laboratory value can be assessed as a tumor marker to evaluate a patient for testicular malignancy? - Serum bilirubin - Amylase - Alpha-Fetoprotein - Adrenocorticotropic hormone
alpha-fetoprotein
deferential artery
arises from the vesicle artery and supplies the vas deferens and epididymis
Enlargement of the prostate in older men is most often caused by: - Prostatitis - Prostate cancer - Benign prostatic hypertrophy - Klinefelter syndrome
benign prostatic hypertrophy
The most common location of a hydrocele is: - Superior to the testis - Within the scrotal wall - Between the two layers of the tunica vaginalis - Between the tunica vaginalis and tunica albuginea
between the two layers of the tunica vaginalis
hematocele
blood located between the visceral and parietal layers of the tunica vaginalis
ejaculatory ducts
connect the seminal vesicle and the vas deferens to the urethra at the verumontanum
varicocele
dilated veins in the pampiniform plexus primary varicocele is usually on the left side ! can have palpable mass and cause infertility
Beta hCG
human chorionic gonadotropin is produced during pregnancy but is also secreted by certain testicular cancers
A simple fluid collection surrounding the testis is referred to as a: - Hematocele - Hydrocele - Varicocele - Spermatocele
hydrocele
Which of the following is consistent with the sonographic features of testicular abscess? - Hyperemic flow around the abscess but not within it - Onion skin sonographic appearance and hyperemic epididymis - Hyperemic flow within an anechoic mass - Hyperemic flow within the abscess but not around it
hyperemic flow around the abscess but not within it
All of the following are sonographic findings consistent with the diagnosis of testicular torsion except: - Hyperemic flow within the testis - Hypoechoic testis - Reactive hydrocele - Decreased intratesticular flow (as compared with the asymptomatic testis)
hyperemic flow within the testis
You have been asked to perform a study to rule out cryptorchidism. The term cryptorchidism denotes: - One or both of the testicles have a malignancy - That the testicle has torsed - One or both of the testicles have not descended into the scrotum - The patient has been kicked in the scrotum
one or both of the testicles have not descended into the scrotum
seminal vesicles
reservoirs for sperm located posterior to the bladder
Primary varicoceles are associated with all of the following EXCEPT: - Left-sided location - Retroperitoneal mass - Infertility - Palpable extratesticular mass
retroperitoneal mass
appendix testis
small oval structure located under the head of the epididymis
The exocrine function of the testicles is to produce: - Testosterone - Human chorionic gonadotropin - Alpha-Fetoprotein - Sperm
sperm
orchiopexy
surgical procedure done to fasten a undescended testicle into the scrotum or repair an acute testicular torsion
peronium
taint!
recurrent rami
terminal ends of the centripetal arteries that curve backward toward the capsule =straight arrow centripetal artery =curved arrow
cryptorchidism
testicles remain within the abdomen or groin and fail to descend into the scrotal sac, undescended testicle
Acute onset of testicular pain at rest is a common clinical finding with: - Testicular carcinoma - Hydrocele - Testicular trauma - Testicular torsion
testicular torsion
The endocrine function of the testicles is to produce: - Testosterone - Human chorionic gonadotropin - Alpha-Fetoprotein - Sperm
testosterone
The most common location of a varicocele is: - The right side of the scrotum - The left side of the scrotum - The inguinal canal - Within the testis
the left side of the scrotum
infarction
tissue death/necrosis that occurs due to lack of blood flow (can be caused by testicular torsion)
urethra
tubular structure that extends from the bladder to the end of the penis
Which of the following techniques is useful for providing sonographic evidence of a varicocele? - Valsalva maneuver - Sitting position - Pulsed Doppler - Right lateral decubitus position
valsalva maneuver
A dilated group of veins found within the scrotum is called a: - Varicocele - Spermatocele - Seminoma - Hydrocele
varicocele
What scrotal abnormality is caused by incompetent valves within the pampiniform plexus? - Testicular carcinoma - Testicular microlithiasis - Testicular torsion - Varicocele
varicocele
Blood supply to the penis
- 2 cavernosal arteries *lateral * parallel, linearm echogenic structures in center of corpora in sagittal plane - 2 dorsal arteries: dorsal - 2 dorsal veins * emissary veins perforate tunica albuginea and drain into dorsal veins * veins become compressed between stiff tunica albuginea and engorged, resulting in maintenance of erection
What are the 3 columns of spongy vascular tissue in the penis? Penis anatomy!!!!!!!!!!!!!!????
- Dorsal side: 2 corpora cavernosa (CC), * sinusoidal cavities are responsible for erection * tunica albuginea surrounds the CC - Ventral side: 1 corpus spongiosum *lies between the CC * Glans penis: bulbous end, and supports prepuce
what is Cowper's gland
- excretes pre-ejaculate - neutralizes urethra - may pick up sperm from previous ejaculations
Anatomy of the penis
- Radix: root - Corpus: body dorsal and is the superior in the flaccid ventral which is the inferior when flaccid
pudendal artery
Partially supply the scrotal wall and epididymis and occasionally the lower pole of the testis
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body of epididymis
seminomas
germ cell tumors
What is the most common correctable cause of male infertility? - Varicocele - Chlamydia - Hydrocele - Testicular torsion
varicocele
Physiology of the penis
- arteries of penis dilate with blood upon stimulation - blood fills 3 spongy chambers of tissue - engorged tissues compress veins, severely limiting or eliminating venous flow - erection is maintained
Vas Deferens
- connects epididymis to ejaculatory duct (seminal vesicles) - smooth muscle - propels sperm forward - joins seminal vesicle, forming ejaculatory duct - 30cm in length - part of the spermatic cord - vasectomy
spermatocele
- cyst in the vas deferens containing sperm (vas deferens connects to the epididymis, tend to arise from head of epididymis) - retention cyst that involves the seminiferous tubules containing sperm
testis
- located in the scrotum
epidermoid ?
Pertaining to the epididymis of the skin
AFP
alpha fetoprotein level that may be elevated with hepatocellular carcinoma and certain testicular cancers
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efferent ductules
sonographic appearance of cryptorchidism
homogeneous ellipsoid mass in inguinal canal
what is the corona of the penis
rounded base of glans
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septa
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tunica vaginalis
tunica albuginea
- inner fibrous membrane surrounding the testicle - white, fibrous capsule that surrounds the testicle
Lymphoma
Growth of new tissue in the lymphatic system
Hernia
The protrusion of part of an organ through the wall that normally contains it
what are the segment of the epididymis
- Head: largest (15mm), superior, appendix epididymis - Body: posterolateral (<4mm) - Tail - ductus epididymis - vas deferens
pampiniform plexus
- Plexus of veins in the spermatic cord that drain into the right and left testicular veins - a network of veins that drains the epididymis and testis
what are the lobules of the testis
- Seminiferous tubules: make sperm, converge to form rete testis - Leydig cells: make testosterone - Bare area: posterior - Appendix testis: embryologic remnant
Causes of erectile dysfunction
- age - health: hypertension, low testosterone, peripheral vascular disease - venous leak: pelvic steal - arterial vasospasm - Peyronie's disease
Hematocele
Extratesticular hematoma
Incarcerated
Imprisoned, confined, restricted
Orchitis
Inflammation of a testis. May be caused by injury, mumps virus, or other infections.
a patient presents to the sonography department for a penile sonogram. He complains of painful curvature of the penis and impotence. What is the most likely diagnosis - Squamous cell carcinoma - Peyronie disease - Tinner syndrome - Testicular fracture
Peyronie Disease
Cryptorchidism
Testicles that do not descended into the scrotal sac
Inguinal canal
The canal carrying the spermatic cord
epididymis
anatomic structure formed by the network of ducts leaving the mediastinum testis that combine into a single, convoluted epidydimal tubule
teratomas
congenital tumors that contain embryonic elements of all three primary germ cell layers
What is in the spermatic cord?
cremasteric muscle vas deferens testicular artery pampniform plexus possibly hernia sac genital branch of genitofemoral nerve
Peyronie's disease on U/S
curvature of the penis due to fibrous tissue deposits around the corpora cavernosa
epididymal cyst
cyst filled with clear, serous fluid located in the epididymis
sonographic appearance of orchitis
decreased echogenicity, possible hydrocele, increased blood flow, testicular atrophy in chronic orchitis
what does the median raphe do
divides the scrotum into two
Signs and symptoms of choriocarcinoma (MALIGNANT)
elevated hCG level with or without palpable mass
sonographic appearance of epididymitis
enlarged epididymis with decreased echogenicity, hyperemia, hydrocele
signs and symptoms of lymphoma/leukemia (scrotal)
enlarged testicles with or without palpable mass, known disease
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epi tail
Which of the following is a benign intratesticular mass that typically has a whorled or onion skin sonographic appearance? - Seminoma - Teratoma - Epidermoid cyst - Adrenal rest
epidermoid cysts
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epididymal head
Which of the following is not a component of the spermatic cord? - Epididymis - Testicular artery - Cremaster muscle - lymph nodes
epididymis
sonographic appearance of hydrocele
fluid collection anterolateral to surrounding testis
hydrocele
fluid formed between the visceral and parietal layers of the tunica vaginalis
sonographic appearance of infarction (scrotal)
focal hypoechoic lesion or entire testis
Signs and symptoms of hydrocele
general scrotal enlargement
What would be the most likely sonographic appearance of a seminoma? - Hyperechoic - Anechoic - Heterogeneous with calcifications - Hypoechoic
hypoechoic
sonographic appearance of lymphoma/leukemia
hypoechoic area or enlarged testicle with possible anechoic portions
sonographic appearance of a teratoma
hypoechoic to hyperechoic usually complex mass, possible shadowing
sonographic appearance of embryonal cell carcinoma (malignant germ cell tumor)
hypoechoic, may have echogenic areas or shadowing calcifications
sonographic appearance of varicocele
increased blood flow in prominent veins with valsalva, usually on left; vessels >2mm
orchitis
infection of the testis and epididymis most common cause is chlamydia -elavated wbc
Epididymitis
inflammation of the epididymis
epididymitis
inflammation of the epididymis signs and symptoms: scrotal pain, possible fever, discharge, usually elevated WBC count, UTI
abscess
localized collection of pus
signs and symptoms of seminoma
palpable testicular mass, rarely painful, possible microlithiasis
Signs and symptoms of embryonal cell carcinoma (malignant germ cell tumor)
palpable testicular mass, rarely painful, possibly elevated hCG
The most common location of prostatic cancer is the: - Peripheral zone - Transitional zone - Central zone - Verumontanum
peripheral zone
signs and symptoms of varicocele
prominent scrotal vessels, especially with standing, infertility
What is the most common cancer found in men? - Testicular cancer - Lung cancer - Liver cancer - Prostate cancer
prostate cancer
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rete testes
sonographic appearance of epididymal cyst
round or oval lesion predominantly anechoic, with enhancement, possible layering; possibly multiple
sonographic appearance of spermatocele
round or oval lesion predominately anechoic, with enhancement, possible layering
sonographic appearance of an abscess (scrotal)
round or oval with irregular wall, hypoechoic, anechoic, or mixed
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seminiferous tubules makes the sperm
A common cyst most often seen in the head of the epididymis that contains nonviable sperm is the: - Epididymal cyst - Tunica albuginea cyst - Spermatocele - Seminoma
spermatocele
Whats doing on
spermatocele and tubular ectasia of rete testis (vasectomy)
What is the most common malignancy of the penis? - Cystadenocarcinoma - Adenocarcinoma - Follicular carcinoma - Squamous cell carcinoma
squamous cell carcinoma
spermatic cord
structure made up of vas deferens, testicular artery, cremasteric artery, and pampiniform plexus that suspends the testis in the scrotum
signs and symptoms of torsion
sudden severe testicular pain, nausea and vomiting
Orchiectomy
surgical excision of a testicle
Signs and symptoms of a hernia
swollen scrotum, pain
Signs and symptoms of infarction (scrotal)
testicular pain, history of inflammation, torsion or trauma
torsion
twisting of the spermatic cord
what is the frenulum or frenum of the penis
underside where foreskin is attached
signs and symptoms of testicular cyst
usually asymptomatic, occult, incidental
What is the anatomy of the scrotum
- scrotal sac -testis -epididymis - vas deferens - spermatic cord
what are the layer of the scrotum
- skin - Darto's muscle: responsible for climate control
Epididymis
- stores sperm - comma shaped - superior and posterolateral
scrotal sac
- stores testis - fibromuscular fibers - climate control
what does the scrotal sac contain
- testis - epididymis - vas deferens - spermatic cord
testis coverings
- tunica albuginea: mediastinum testis, divides into lobules - tunica vaginalis: 2 layers of peritoneum
Spectral and Color Doppler
-forward low resistance flow -scale low, color gain high
partial torsion
-high resistance blood flow
Peyronie's Disease
-painful, deviated erection -Repeated micro traumas -Fibrous plaques form in the tunica albuginea
infarction of testis
-ruptured tunica albuginea -hematocele -infarct
what is the size of a testis
5x4x3cm
Human chorionic gonadotropin
Hormone secreted by the placenta
Epididymoorchitis
Inflammation of the epididymis AND corresponding testis!!!!!!!!! most common male reproductive condition causing acute pain
tunica vaginalis
Membrane consisting of a visceral layer and a parietal layer lining the inner wall of the scrotum
sonographic appearance of torsion
initially, enlarged hypoechoic testicle with diminished or absent blood flow
sonographic appearance of choriocarcinoma (malignant)
intratesticular mass with mixed echogenicity
sonographic appearance of rupture (scrotal)
irregular testicular outline with hypoechoic or hyperchoic areas, extratesticular soft tissue
verumontanum
junction of the ejaculatory ducts with the urethra
dartos
layer of muscle underneath the scrotal skin that wrinkles the skin
Secondary varicoceles are most likely associated with all of the following EXCEPT: - Left-sided location - Right-sided location - Hepatomegaly - Renal mass
left sided location (most common location of a varicocele is at left side of scrotum)
testicle
male gonad that produces hormones that induce masculine features and spermatozoa
testicle
male gonad; one of two reproductive organs located in the scrotum
chlamydia
microoranisms that cause a wide variety of disease including urethritis
septa of testis
multiple septa formed from the tunica albuginea that course toward the mediastinum testis and separate the testicle into lobules
rete testis
network of the channels formed by the convergence of the straight seminiferous tubules in the mediastinum testis
All of the following are sonographic findings consistent with torsion of the testicular appendage except: - No intratesticular flow - Small hyperechoic mass adjacent to the testis - Reactive hydrocele - Scrotal wall thickening
no intratesticular flow
what is the meatus of the penis
opening of urethra on corpus spongiosum
Signs and symptoms of orchitis
pain, fever, nausea, vomiting, exquisitely tender scrotum, elevated WBC, UTI, or trauma
signs and symptoms of rupture (scrotal)
painful to touch, recent trauma, scrotal edema
Signs and symptoms of adenomatoid tumor (scrotum) benign
painless extratesticular nodule
Signs and symptoms of epidermoid cyst
palpable testicular mass
signs and symptoms of a teratoma
palpable testicular mass, rarely painful
sonographic appearance of testicular cyst
round or oval, anechoic, thin walled, acoustic enhancement
scrotum
sac containing the testes and epididymis
sonographic appearance of a hernia
scrotal mass with variable echogenicity pattern; peristaltic motion may be identified
Signs and symptoms of an abscess (scrotal)
scrotal pain, fever, nausea and vomiting, history of UTI, possibly elevated WBC count
signs and symptoms of epididymitis
scrotal pain, possible fever, discharge, usually elevated WBC count, UTI
Zinner syndrome consists of unilateral renal agenesis, ejaculatory duct obstruction, and - Prostate cancer - Seminoma - Bulbourethral stones - Seminal vesicle cysts
seminal vesicle cysts (ipsilateral)
Spermatogenesis occurs within the: - Tunica albuginea - Rete testis - Mediastinum testis - Seminiferous tubules
seminiferous tubules
The most common germ cell tumor of the testis is the: - Yolk sac tumor - Embryonal cell carcinoma - Seminoma - Teratoma
seminoma associated w/ increase in AFP and hCG!!!!!!!!!!!!!!!
What is the most common malignancy of the testicles? - Embryonal cell carcinoma - seminoma - choriocarcinoma - spermatocele
seminoma (germ cell tumor)
tunica vaginalis
serous membrane that surrounds the font and sides of the testicle2
A 7-year-old boy presents to the emergency department with acute testicular pain localized to the superior pole of his right testis. What is the most likely diagnosis? - Testicular torsion - Hydrocele - Torsion of the testicular appendage - Yolk sac tumor
torsion of the testicular appendage
the blue dot is indicative of: - testicular torsion - Epididymitis - Orchitis - Torsion of the testicular appendage
torsion of the testicular appendage
The most common location of BPH is the: - Peripheral zone - Transitional zone - Central zone - Verumontanum
transitional zone
vas deferens
tube that connects epididymis to the seminal vesicles vasectomy here
During a sonographic examination of the right testis, you visualize multiple small cysts located along the mediastinum testis. What is the most likely diagnosis? - Epididymitis - Tubular ectasia of the rete testis - Multiple spermatoceles - Epidermoid cysts
tubular ectasia of the rete testes
Reasons for a penis ultrasound
- evaluate for arterial insufficiency - erectile dysfunction, unable to obtain or maintain an erection - Peyronie's disease: curved painful penis with an erection, it is a connective tissue disorder with scar tissue buildup in tunica albuginea from chronic inflammation, can result in erectile dysfunction
signs and symptoms of scrotal tumor
painless testicular mass or enlargement
Signs and symptoms of cryptorchidism
palpable mass in inguinal canal
malignant testicular tumors ? GENERAL INFO NEED TO KNOW
-Most intra-testicular lesions are malignant Symptoms: -palp mass -chronic pain -heaviness in scrotal sac * most common is germ cell tumor (serinoma) - has elavated AFP, hCG (epidermoid cyst = top right; still remove teste)
Hydrocele
Accumulation of serous fluid in the tunica vaginalis testis
Which of the following best describes a spermatocele? - The most common malignant neoplasm of the scrotum - A benign intratesticular cyst - A cyst, found within the head of epididymis, that may contain debris - A dilated group of veins found within the scrotum
a cyst, found within the head of the epididymis, that may contain debris
